超声检查在成人小肠扭转诊断中的应用价值  

The application of ultrasound in the diagnosis of small bowel volvulus in adults

作　　者：罗焱文 朱庆莉[1] 李文波[1] 刘炜 丛林 韩显林 韦颍昕 张冠南 孝梦甦 马莉 Luo Yanwen;Zhu Qingli;Li Wenbo;Liu Wei;Cong Lin;Han Xianlin;Wei Yingxin;Zhang Guannan;Xiao Mengsu;Ma Li(Department of Ultrasound,Peking Union Medical College Hospital,Peking Union Medical College and Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Radiology,Peking Union Medical College Hospital,Peking Union Medical College and Chinese Academy of Medical Sciences,Beijing 100730,China;Department of General Surgery,Peking Union Medical College Hospital,Peking Union Medical College and Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]中国医学科学院、北京协和医学院、北京协和医院超声医学科,北京100730 [2]中国医学科学院、北京协和医学院、北京协和医院放射科,北京100730 [3]中国医学科学院、北京协和医学院、北京协和医院基本外科,北京100730

出　　处：《中华外科杂志》2023年第10期907-912,共6页Chinese Journal of Surgery

基　　金：中央高水平医院临床科研业务费资助(2022-PUMCH-B-066);国家自然科学基金(81971640);中国医学科学院医学与健康科技创新工程项目(2017-I2M-1-006)。

摘　　要：目的探讨小肠扭转的超声表现及超声在成人小肠扭转诊断中的价值。方法回顾性收集2017年8月至2022年10月北京协和医院经临床诊断或手术证实为小肠扭转并有超声检查记录的34例患者资料, 其中男性19例, 女性15例, 年龄(55.0±21.8)岁(范围:19~94岁)。分析34例患者的临床特征、CT影像及超声声像图特征, 并分析超声检查对小肠扭转的诊断价值。结果 34例患者临床症状均表现为腹痛, 其中21例伴腹胀, 19例伴恶心呕吐, 13例出现排气排便停止。8例患者出现腹膜炎体征, 22例肠鸣音异常。20例患者既往有腹部手术病史。34例小肠扭转的患者中, 27例患者因并发肠梗阻行手术治疗, 余7例经保守治疗后好转。超声检查结果显示, 11例可见"漩涡征"而明确诊断为小肠扭转, 诊断率为32.4%(11/34), 超声检查同时诊断肠梗阻21例, 腹水17例, 另肠壁增厚4例, 腹部包块2例, 肠套叠1例, 右侧腹股沟疝1例。88.2%(30/34)的患者CT和超声检查有一致的阳性发现。结论超声检查在小肠扭转的诊断及并发症评估方面有一定价值。Objective To analyze the ultrasound characteristics of small bowel volvulus among adults and to investigate the value of ultrasound in the diagnosis of small bowel volvulus.Methods Totally 34 adults with small bowel volvulus confirmed by clinical diagnosis or surgery and who underwent ultrasound examination at Peking Union Medical College Hospital from August 2017 to October 2022 were enrolled,including 19 males and 15 females,aged(55.0±21.8)years(range:19 to 94 years).The clinical characteristics,CT images and ultrasound images of the patients were retrospectively reviewed,and the ultra,sound features of small bowel volvulus and its diagnostic efficacy were analyzed.Results Abdominal pain was the typical clinical symptom of all patients.Other symptoms included 21 cases of abdominal distension,19 cases of nausea and vomiting,and 13 cases of cessation of passage of stool or flatus.Eight patients had signs of peritonitis and 22 patients had abnormal bowel sounds.Twenty patients had a history of abdominal surgery.Twenty-seven patients underwent surgery for intestinal obstruction,and the remaining 7 patients improved after conservative treatment.All cases were evaluated by ultrasound,11 cases showed a“whirl sign”and were diagnosed as small bowel volvulus,the diagnostic accuracy rate was 32.4%(11/34),ultrasound simultaneously diagnosed intestinal obstruction in 21 cases,17 cases of abdominal effusion,4 cases of intestinal wall thickening,2 cases of abdominal mass,1 case of intussusception,1 case of right sided inguinal hernia.CT and ultrasound had a consistent positive discovery in 88.2%(30/34)of all the patients.Conclusion Ultrasound is valuable in the diagnosis of small bowel volvulus and the evaluation of complications.

关 键 词：肠扭转 超声检查 急腹症 

分 类 号：R656[医药卫生—外科学] R445.1[医药卫生—临床医学]